I recently met a Director of Public Health. We were both in the lunch queue at a conference which was focusing on civil contingencies, the needs of people in disasters and organisational structures for addressing local resilience.

As we queued I asked her about provision of psychological (trauma) support services in her area for addressing the needs of people in the event of a major emergency. She replied, somewhat curtly, that she did not know: it was not her responsibility she said; it was not her budget. I was told I obviously hadn’t read the Health and Social Care Act, 2012.

Somewhat bemused, I sought reassurance. Perhaps I had misunderstood; she was not suggesting that psychological support services are not to do with public health? Sadly, I did not get that reassurance.

Just to be clear I went away and re-read the Act, and also the Department of Health’s guidance on the roles and responsibilities of Directors of Public Health in Local Government. This says that, among other things, Directors of Public Health (DPH) should offer leadership, expertise and advice on a range of issues, from emergency preparedness through to improving local people’s health and concerns around access to health services.

With regard to health emergency, preparedness resilience and response (EPRR) the role of Local Authorities, via their DPH, is to:

Provide leadership for the public health system within their local authority area;

Take steps to ensure that plans are in place to protect the health of their populations, and

Fulfill the responsibilities of a Category 1 responder under the Civil Contingencies Act.

This is encapsulated in the Emergency Preparedness Framework 2013 (NHS Commissioning Board, 2013).

At a time of tight budgetary constraint, and pressures on all those working within our public services, keeping trauma support and other mental health services on the agenda remains a formidable challenge in ordinary time, let alone in the context of major emergencies and disasters.

Perhaps this helps to explain why psychological support services, and indeed broader aspects of humanitarian assistance, remain the poor relation when it comes to emergency planning, response and longer term recovery in so many areas of the country. But these are integral aspects of public health, and not just in the event of disasters.

It is a worrying thought that our sense of health responsibility could become limited only to those activities over which we have direct budgetary control. Directors of Public Health in particular have a key role to play in delivering real improvements in local health in today’s health system. They are corporately and professionally accountable; with such seniority comes responsibility.

The challenge and expectation on all those who lead on health-related initiatives before, during and after emergencies, is that they will think holistically about people, across phases of disaster, beyond rigid organisational structures and within a multiagency framework in responding to the needs of their communities. For a long time this idea has been encapsulated in the concept of integrated emergency management and it is integral to so many of our organisational philosophies today.

I think it is important that we never forget that public health is about people and that responding to disasters – before, during and after they strike – is about helping and supporting people, including through the provision of robust public mental health services. This is not to say it is easy, and not to acknowledge that addressing mental health and other needs in today’s world of limited budgets and organisational structures can be difficult. However the challenge to those in leadership positions, and indeed all of us, is to work with and through these, not be constrained by them.

The public and those we serve will help ground us in this. Try telling those affected by the recent floods, or any other disaster for that matter, that public health in emergencies is not to do with psychological support.

Uncertainty shrouds the future of public health. Or so it seems if the responses of the 1,160 Faculty of Public Health members, who took part in FPH’s survey on the NHS White Paper, are anything to go by.

But despite the many question marks around the proposed reorganisation, FPH’s specialist public health members still manage to be pretty damning. Nearly 40% of respondents doubted the White Paper would have a positive impact on population health. Furthermore, the majority (38.3%) believed that the proposed new structures would offer worse or much worse value for money. Many highlighted the fact that the healthcare public health strand of the specialty was simply ‘forgotten’, with 56.9% saying that public health as a whole wasn’t sufficiently covered.

There’s also drive and energy out there – public health teams are proud of their expertise and skills, and know their input is vital to the communities they work in around the country. The independent advocacy role of the director of public health was one area they were ready to defend. 98.3% thought that the DPH should be free to report objectively on the health impact of local policies. And 91.5% said the DPH should report independently on the population’s health.

It’s not all doom and gloom, however. Despite the fact that no-one has mentioned the plans to change the ‘Department of Health’ to ‘Department of Public Health’ for a while now, the public health workforce does seem quietly hopeful that the reorganisation will create a better and more efficient national public health service. The Coalition Government’s apparent commitment to public health hasn’t gone unnoticed.

Public health specialists are clearly keeping an open mind while waiting for the uncertainty to lift. But their hope, energy and loyalty should not be taken for granted. Nearly half (46.8%) of the respondents thought that the changes and uncertainty would mean fewer trainees applying to work in public health. If they are right, the future of public health – and the public’s health – is on very shaky grounds indeed.

Disclaimer

The aim of this blog is to encourage discussion and debate on public health issues. The views expressed here are the personal views of authors, and the content does not reflect the official position of the Faculty of Public Health. However, discussion generated here may be used to influence the development of organisational policy.